Diseases Category Research Articles

The impact of comorbid psychiatric disorders on chronic obstructive pulmonary disease (COPD) hospitalizations: a nationwide retrospective study.

To characterize the register of a secondary diagnosis of mental illnesses in all chronic obstructive pulmonary disease (COPD) hospitalizations registered in Portugal from 2008 to 2015 and explore their impact on hospitalization outcomes. A retrospective observational study was conducted. Hospitalizations of patients with at least 40 years old, discharged between 2008 and 2015 with a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were retrieved from a national administrative database. Comorbid psychiatric diagnoses were identified and defined by the HCUP Clinical Classification Software (CCS) category codes 650-670 (excluding 662). Length of hospital stay (LoS), admission type, in-hospital mortality, and estimated hospital charges were analyzed according to psychiatric diagnostic categories using sex and age-adjusted models. Of 66,661 COPD hospitalizations, 25,869 (38.8%) were episodes with a registered psychiatric comorbidity. These were more likely to correspond to younger inpatients (OR = 2.16, 95%CI 2.09-2.23; p < 0.001), to stay longer at the hospital (aOR = 1.08, 95%CI 1.05-1.12; p < 0.001), to incur in higher estimated hospital charges (aOR = 1.37, 95%CI 1.33-1.42; p < 0.001) and to be urgently admitted (aOR = 1.33, 95%CI 1.23-1.44; p < 0.001). After adjustment for age, in-hospital mortality was lower for episodes with psychiatric diagnoses (aOR = 0.90; 95%CI 0.84-0.96; p < 0.001), except for organic and neurodegenerative diseases category and developmental disorders, intellectual disabilities and disorders usually diagnosed in infancy, childhood, or adolescence category. These findings corroborate the additional burden placed by psychiatric disorders on COPD hospitalizations, highlighting the importance of individualizing care to address these comorbidities and minimize their impact on treatment outcomes.

Clinical Accuracy Of Dermatologists And Nondermatologists In The Diagnosis Of Dermatological Diseases.

To compare the clinical diagnostic accuracy of dermatologists and non- dermatologists in the diagnosis of dermatological diseases. The descriptive, cross-sectional study was conducted at the Dermatopathology department of a tertiary healthcare hospital in the Punjab province of Pakistan from January 1 to December 31, 2019, and comprised biopsy specimens of patients with diseases of the skin and subcutaneous tissue. The clinical diagnoses of general surgeons, otolaryngologists, dental/maxillofacial surgeons, plastic surgeons and gynaecologists were noted and compared with those of dermatologists in the light of histopathological findings. Data was analysed using SPSS 16. Of the 386 specimens submitted, 113(29.3%) were sent by dermatologists and 273(70.7%) by non-dermatologists. Clinical diagnostic accuracy of dermatologists 92(81.4%) compared to non-dermatologists 137(50.2%) (p<0.005). The dermatologists diagnosed significantly more cases belonging to inflammatory and miscellaneous cutaneous diseases category accurately than non-dermatologists (p<0.005). Similarly, the dermatologists diagnosed significantly more cases of neoplastic disorders accurately than the non-dermatologists (p= 0.018). There was no significant difference in the clinical diagnostic accuracy of dermatologists and non-dermatologists in cases of cystic lesions (p>0.05). In the neoplastic category, no significant difference was found in the clinical accuracy of dermatologists and plastic surgeons (p=0.347). The specialised skills of dermatologists could not be matched by any other group of physicians.

Cell Disease Identification Using Enhanced Salp Swarm Algorithm in Machine Learning

Computerized diagnosis of white blood cells cancer diseases for instance Leukemia and Myeloma is a demanding biomedical research area. Our method presents for the first time a new state of the application that assists in diagnosing the white blood cells diseases. We divide these diseases into two types; each type includes similar symptoms a disease that may my method is applied on one of the two diseases category by computing different features. Finally, Random Forest classifier is enforced for final decision. The proposed method aims to early discovery of white blood cells cancer, reduce the misdiagnosis cases in adding up to develop the system learning methodology. Moreover, allowing the experts only to have the final modification on the result obtained from the system. The proposed approach achieved an accuracy of 93% in the first type and 95% in the second type.

Ethnobotanical Study on Medicinal Plants Used by the Local Communities of Ameya District, Oromia Regional State, Ethiopia

In the present study, the diversity of medicinal plants and associated traditional medicinal knowledge of the rural community in the Ameya district in Ethiopia was assessed and documented. A survey was conducted through semistructured interviews, guided field walks, focus group discussions, and field observations. The snowball and purposeful sampling techniques were employed to select general and knowledgeable informants, respectively. Accordingly, a total of 210 respondents, 156 (74.3%) males and 54 (25.7%) females, were participated in this study. The informants were selected from seven kebeles (the lowest administrative units) following the recommendations of the local community for the availability of traditional medicinal plant use practice. Descriptive statistics, preference ranking, fidelity level, informant consensus factor, and direct matrix ranking were used to analyze and present the data. A total of 78 medicinal plants represented in 70 genera and 40 families were identified. Croton macrostachyus and Dodonaea viscosa were the most preferred species used to treat wounds, whereas Cucumis ficifolius and Phragmanthera macrosolen were the most popular species applied to treat stomachache. Leaves (38%) and roots (20%) were the most predominantly used plant parts for remedial preparation to treat 42 human ailments. The informant consensus factor (ICF) value ranged between 0.45 and 0.81, with the respiratory diseases category scoring the highest ICF value. The fidelity level (FL) value for the medicinal plants ranged from 24 to 95%. Considerable proportions (55.5%) of the medicinal plants were collected from wild habitats. Higher ICF (0.81) and FL (&gt;90%) scores indicate the presence of rich traditional knowledge in the community. This knowledge can be used to select medicinal plants (such as Croton macrostachyus, Cucumis ficifolius, Dodonaea viscosa, and Phragmanthera macrosolen) for further pharmacological and phytochemical studies.

Factors Related to The Utilization of The Integrated Development Posts of Non-Convenient Diseases in The Pandemic Era in The Work Area of Sekolaq Health Centre in 2022

Introduction: Integrated Development Post of Non-Convenient Diseases is an activity for early detection and monitoring of risk factors for Non-Communicable Diseases that is oriented towards promotive and preventive efforts, from data on 593 patient visits during the pandemic era at the Sekolaq Darat District Health Centre, more than 92% were included in the Non-Communicable Diseases category and only 39% of sufferers of Non-Communicable Diseases attended the Integrated Non-Communicable Diseases Guidance Post. Objective: This study aims to describe and examine the relationship between variables, namely factors related to the use of Non-communicable Disease Integrated Development Posts in the Pandemic Era. Methods: The research design is a descriptive correlation with a cross-sectional approach. The statistical test used is nonparametric with Chi-Square. Results and Discussion: The relationship between knowledge, support from health workers, family support, and attitudes with the utilization of Integrated Development Post of Non-Convenient Diseases obtained p-value = 0.00&lt;0.05 and the relationship between work and utilization of Integrated Development Post of Non-Convenient Diseases obtained p-value = 0.09&gt;0.05. Conclusion: Knowledge, support from health workers, family support and attitudes are factors related to the utilization of the Non-Communicable Diseases Integrated Development Post

Blockbuster effect of COVID-19 on the impact factor of infectious disease journals

Blockbuster effect of COVID-19 on the impact factor of infectious disease journals

What the grey literature can contribute to addictive behaviour disorder classification •.

This commentary examines the proposal made by Brand et al. (2022) regarding a framework outlining relevant criteria for considering possible behavioural addictions within the current World Health Organisation's International Classification of Diseases (ICD-11) category of ‘other specified disorders due to addictive behaviours’. We agree with the framework as it highlights the clinical perspective requiring agreed-upon classifications and criteria to produce effective diagnostic procedures and efficacious treatments. Additionally, we propose to add the need of recognising potential addictive behaviour through the inclusion of a fourth meta-level criterion: ‘grey literature evidence’. Utilising non-academic evidence can provide validity in the social context where the behaviour takes place, and it can support authorities in taking action to prevent and treat the resultant behavioural problems. The inclusion of the proposed fourth criterion will aid comprehensibility of the current proposal and provide clarity, as indicated in the present commentary, which includes the fourth criterion analysis for problematic pornography use, shopping/buying and social networking site use.

Evaluation of Histomorphological Spectrum of Skin Lesions at a Teaching Institute in Agra: A Cross-sectional Study

Introduction: The skin is the largest organ system in humans. Different skin diseases consist of non specific, non infectious and infectious diseases to various neoplastic lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country and influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. The clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and few others. However, the spectrum of histopathology of skin disorders is varied. Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions. Aim: To study histomorphological spectrum and distribution of skin lesions. Materials and Methods: This hospital-based crosssectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal Diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years from September 2019 to August 2021. The biopsy sample taken from clinically diagnosed skin lesions sent to histology laboratory in 10% formalin. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with Haematoxylin and Eosin (H&amp;E) stain and histology was studied under microscope. Special stains such as Ziehl-Neelsen (Z-N) stain and Fite stain were done, whenever required. Data was entered in Microsoft Excel excel and descriptive data was obtained. Results: Out of total 105 cases, the maximum patients were of 21-30 years of age group 30 (28.57%) cases followed by 11-20 years of age group 25 (23.81%) cases with male and female ratio M:F=1.5:1. In this study, out of total 105 cases, the most common site involved was trunk in 42 (42%) cases followed by upper limb in 25 (23.81%) cases. The most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases. In non infectious papulosquamous diseases group found 25 (23.81%) cases followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases. Infectious diseases were seen in 22 (20.95%) cases, out of which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection 2 (1.90%) cases. Conclusion: According to the findings of the present study the major cases of skin lesions requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity.

Predicting Regional Outbreaks of Hepatitis A Using 3D LSTM and Open Data in Korea

In 2020 and 2021, humanity lived in fear due to the COVID-19 pandemic. However, with the development of artificial intelligence technology, mankind is attempting to tackle many challenges from currently unpredictable epidemics. Korean society has been exposed to various infectious diseases since the Korean War in 1950, and to overcome them, the six most serious cases in National Notifiable Infectious Diseases (NNIDs) category I were defined. Although most infectious diseases have been overcome, viral hepatitis A has been on the rise in Korean society since 2010. Therefore, in this paper, the prediction of viral hepatitis A, which is rapidly spreading in Korean society, was predicted by region using the deep learning technique and a publicly available dataset. For this study, we gathered information from five organizations based on the open data policy: Korea Centers for Disease Control and Prevention (KCDC), National Institute of Environmental Research (NIER), Korea Meteorological Agency (KMA), Public Open Data Portal, and Korea Environment Corporation (KECO). Patient information, water environment information, weather information, population information, and air pollution information were acquired and correlations were identified. Next, an epidemic outbreak prediction was performed using data preprocessing and 3D LSTM. The experimental results were compared with various machine learning methods through RMSE. In this paper, we attempted to predict regional epidemic outbreaks of hepatitis A by linking the open data environment with deep learning. It is expected that the experimental process and results will be used to present the importance and usefulness of establishing an open data environment.

Refolding of metacaspase 5 from Trypanosoma cruzi, structural characterization and the influence of c-terminal in protein recombinant production

Metacaspases are known to have a fundamental role in apoptosis-like, a programmed cellular death (PCD) in plants, fungi, and protozoans. The last includes several parasites that cause diseases of great interest to public health, mostly without adequate treatment and included in the neglected tropical diseases category. One of them is Trypanosoma cruzi which causes Chagas disease and has two metacaspases involved in its PCD: TcMCA3 and TcMCA5. Their roles seemed different in PCD, TcMCA5 appears as a proapoptotic protein negatively regulated by its C-terminal sequence, while TcMCA3 is described as a cell cycle regulator. Despite this, the precise role of TcMCA3 and TcMCA5 and their atomic structures remain elusive. Therefore, developing methodologies to allow investigations of those metacaspases is relevant. Herein, we produced full-length and truncated versions of TcMCA5 and applied different strategies for their folded recombinant production from E. coli inclusion bodies. Biophysical assays probed the efficacy of the production method in providing a high yield of folded recombinant TcMCA5. Moreover, we modeled the TcMCA5 protein structure using experimental restraints obtained by XLMS. The experimental design for novel methods and the final protocol provided here can guide studies with other metacaspases. The production of TcMCA5 allows further investigations as protein crystallography, HTS drug discovery to create potential therapeutic in the treatment of Chagas' disease and in the way to clarify how the PCD works in the parasite.

The Utilization of Medicinal Plants to Cure Gastrointestinal Disorders by The Dayak Muara Tribe in Kuala Dua Village, Sanggau Regency

People use medicinal plants to treat various diseases, one of which is gastric disorders. The study aims to analyze the use of medicinal plants to overcome gastric disorders by the Dayak Muara tribe in Kuala Dua Village, Sanggau Regency. The sampling method was purposive sampling, with the number of respondents was 10% of the total number of households in Kuala Dua Village (91 respondents). The information regarding the medicinal plants used by the Dayak Muara tribe to overcome gastric disorders such as diarrhea, intestinal worms, nausea and vomiting, constipation, gastric, flatulence, and stomachache was collected. Furthermore, data obtained analyzed for the use-value (UV), informant consensus factor (ICF), and fidelity level (FL). The Dayak Muara tribe in Kuala Dua village, Kembayan District, has used 17 species of medicinal plants to overcome gastric disorders. Curcuma longa is the plant with a high use value or UV (0.96), followed by Psidium guajava (0.89) and Zingiber officinale (0.45). The highest value of informant consensus factor or ICF includes the diseases category of diarrhea (0.98), gastric, stomachache, nausea, and vomiting, each of which has an ICF value (0.96), constipation (0.94), intestinal worms and flatulence (0.88). The plants with the highest fidelity level (FL) are Allium sativum, Cymbopogon citratus and Centella asiatica for gastric (100), Areca catechu for constipation (100), Moringa oleifera, and Theobroma cacao (100) for stomachache.

A survey of traditional medicinal plants used to treat common human and livestock ailments from Diguna Fango district, Wolaita, southern Ethiopia

Plants have been used as a traditional medicine for many years for the people of Wolaita, Ethiopia. The aim of the study was to record the local knowledge of the peoples who inhabit the Diguna Fango district. A semi‐structured interview was conducted with a total of 60 informants. Totally, 50 species belonging to 24 families were identified to treat 28 human and livestock ailments. Solanaceae (14.3%) was the most abundant family whereas; the Rosaceae (1.00) had the highest family use value (FUV). Most of the plants (82%) were reportedly used to treat human diseases. Herbs (34%) were the dominant growth habits, followed by trees (33%). The leaves (30%) were identified as the most used plant part. The most common methods of remedy preparations were eating and chewing (18.2% each) followed by grinding (13.61%). Oral (73.3%) was the major route of administration, followed by dermal (21.7%). The cardiovascular system diseases category (1.00) had a higher informant consensus factor value followed by the fever disease category (0.90). Croton macrostachyus Hochst. ex Delile, Commelina benghalensis L., Triticum dicoccon (Schrank) Schübl. and Pentas arvensis Hiern (100%) had a higher fidelity level to treat swelling, chirt (skin diseases), weight gain and bone fractures, respectively. Persea americana Mill. was ranked highest as the most preferable medicinal plant for various purposes by local people, followed by Acacia abyssinica Benth. The principal threatening factors reported were charcoal production (26%), agricultural expansion (15%) and firewood (14%). Out of the plants and their uses documented, 16% of the medicinal plants and 28.6% of the uses were novel. The present study showed the existence of indigenous knowledge of medicinal plants to treat human and livestock ailments. Therefore, there should be mentoring for the local people in the study area to conserve their indigenous knowledge and resources.

Identification and comparison of circular RNAs in preeclampsia

BackgroundPreeclampsia (PE) is a pregnancy-specific syndrome, belongs to the gestational hypertension diseases category and is considered among the causes of maternal and perinatal mortality and morbidity. However, the pathogenesis of PE is still vague.MethodsIn the present study, the circular RNA (circRNA) expression patterns of normal pregnant women and PE patients were investigated using whole RNA sequencing.ResultsA total of 151 differential expressed circRNAs were identified including 121 upregulated and 30 downregulated ones. Functional and pathway enrichment analysis was conducted on the differentially expressed circRNAs using Gene Ontology and KEGG databases. The results of this analysis indicated that several crucial biological processes and pathways were enriched in PE patients. circRNA–microRNA (miRNA) interaction analysis indicated that the reported differentially expresse circRNAs may be associated with some regulatory functions through miRNAs in PE patients. Two ceRNAs networks were constructed according to the targeting relationship between circRNAs/miRNAs and miRNAs/mRNAs. One sub-network contained one upregulated circRNA, four downregulated miRNAs and five upregulated mRNAs, and another sub-network contained 10 downregulated circRNAs, 21 upregulated miRNAs and 15 downregulated mRNAs.ConclusionCircRNA expression patterns have been investigated and this analysis revealed their potential regulatory mechanisms in PE patients. We constructed the ceRNAs (competing endogenous RNA) to reveal the potential molecular roles of dysregulated circRNAs in the PE patients using RNA sequencing data. circRNA_13301 was the only one upregulated circRNA in ceRNA being targeted by four miRNAs.

Medical Imaging Engineering and Technology Branch of the Chinese Society of Biomedical Engineering expert consensus on the application of Emergency Mobile Cabin CT.

Started during December 2019, following the emergence of several COVID-19 cases in Wuhan City, Hubei Province, there was a rapid surge and spread of new COVID-19 cases throughout China. The disease has since been included in the Class B infectious diseases category, as stipulated in the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases and shall be managed according to Class A infectious diseases. During the early phases of COVID-19 infection, no specific pulmonary imaging features may be evident, or features overlapping with other pneumonia may be observed. Although CT is not the gold standard for the diagnosis of COVID-19, it nonetheless is a convenient and fast method, and its application can be deployed in community hospitals. Furthermore, CT can be used to render a suggestive diagnosis and evaluate the severity as well as the effects of therapeutic interventions for typical cases of COVID-19. The mobile emergency special CT device described in this document (also known as Emergency Mobile Cabin CT) has several unique characteristics, including its mobility, flexibility, and networking capabilities. Furthermore, it adopts a fully independent isolation design to avoid cross-infection between patients and medical staff. It can play an important role in screening suspected cases presenting with imaging features of COVID-19 in hospitals of various levels that provide care to suspected or confirmed COVID-19 patients as part of the first line procedures of epidemic prevention and control.

Traditional medicinal knowledge of woody species across climatic zones in Benin (West Africa)

Ethnopharmacological relevancePlant parts are often used by local people to treat their affections. This study addressed the Traditional Medicinal Knowledge of woody species in Benin and the dependence of medicinal use of woody species on climatic zones. Aim of the studyIt reports (i) the main diseases categories treated with medicinal use of woody species in Benin and changes across climatic zones by inferring their epidemiological status, and (ii) the woody species involved and their distribution according to climate conditions. Materials and methodsEthnobotanical interviews were undertaken using a semi-structured questionnaire. Five hundred and ninety medicinal plant professionals (healers, traders …) were interviewed in the whole country. Frequency of citation and informant consensus factor were calculated to highlight the main human diseases categories and woody species used for their treatment. A principal component analysis was performed to determine the occurrence of diseases categories in different climatic zones. ResultsAbout 94% of international diseases categories were treated using medicinal woody species in Benin. Nighty-seven ailments in 16 diseases categories were identified. Among them, 5 diseases categories (General and unspecified, Digestive, Skin, Neurological, and Musculoskeletal) were highlighted as important. The Sudano-Guinean zone showed the highest diseases frequencies, whereas the Sudanian zone showed the lowest. The epidemiological status of some phytodistricts was worrisome. In our study, 123 woody species belonging to 93 genera and 35 families were reported, and among them, 16 were the most used as treatments. ConclusionsThere is a lack of consensus among traditional healers about which woody species to use. Many different species were used to treat a given diseases category. Also, information concerning their organ composition was not available in the literature, for the majority of species. Biological and chemical investigations are thus needed for a better valorization of the most frequently used plants in the future.

Local knowledge of traditional medicinal plants use and education system on their young of Ammatoa Kajang tribe in South Sulawesi, Indonesia

Abstract. Azis S, Zubaidah S, Mahanal S, Batoro J, Sumitro SB. 2020. Local knowledge of traditional medicinal plant use and education system on their young Ammatoa Kajang tribe in South Sulawesi, Indonesia. Biodiversitas 21: 3989-4002. Kajang tribal community in Indonesia has been using plants as traditional medicine for long periods of time; however, this traditional knowledge has not been appropriately documented. Therefore, to prevent the knowledge from being degraded or vanished, it needs to be documented. This study aimed to (i) document the local knowledge of Ammatoa Kajang tribe on the use of traditional medicinal plants, (ii) describe the education system of their young generation, and (iii) conduct Informant Consensus Factor (ICF) and Use Value (UV) analyses. The research data were obtained from 114 informants through semi-structured interviews. This research uses descriptive analysis, quantitative ICF, and UV. A total of 104 plant species from 50 families were identified. Parts of plants that were frequently used by the tribal community were leaves (48.56%). Before using the medicinal plants, the people customarily boiled (33.09%) the plants. The youth received education through informal education that became the highest level of education delivered orally by the family (51.75%). The highest ICF was found in the Digestive System Diseases category, and the highest UV was observed in Piper betle.

Evaluation of male patients who applied to urology polyclinic with genital lesion

Aim: The aim of this study was to evaluate retrospectively the patients who were referred to the urology clinic with genital skin lesions and evaluated by dermatology. Materaials and Methods: Forty-four male patients over 18 years of age who were applied to urology clinic in the last 4 months with a skin lesion in the genital area and who were evaluated by the department of dermatology were included. Patients who applied to the urology clinic with a skin lesion in the genital area were first evaluated by a urologist. These patients were then directed to the dermatology polyclinic and evaluated by a dermatologist. Results: A total of 44 male patients between 19 and 60 years of age were included in the study. The mean age of the patients was 36.97 ± 12.17. In the inflammatory diseases category, contact dermatitis was found in 11 (25%) patients, lichen simplex chronicus in 2 (4.5%) patients, fix drug eruption in 2 (4.5%) patients, psoriasis in 2 (4.5% , 3) lichen planus in 1 (%2,3) patient, and lichen sclerosus in 1 (2,3%) patient had. In the infectious diseases category, 17 (38.6%) patients had condyloma acuminata, 3 (6.8%) patients had herpes simplex infection and 1 (2.3%) patient had molluscum contagiosum. In the other diseases category, angiokeratom in 2 (4.5%) patients, vitiligo in 1 (2,3%) patient and calcinosis cutis in 1 (2,3%) patient were present. Conclusion: A multidisciplinary approach is needed in the diagnosis and treatment of diseases in the genital region.

A Five-Year Longitudinal Study in Facioscapolohumeral Muscular Dystrophy: Assessment of Variables Influencing Disease Progression

Background: Reduction of tandemly arrayed D4Z4 repeats is diagnostic for facioscapulohumeral muscular dystrophy (FSHD). However, various clinical phenotypes have been observed in carriers of this molecular lesion. Currently their natural history is obscure. Methods: A prospective observational cohort study is conducted to quantify disease progression over five-year follow-up (2013-2016) in246 carriers of D4Z4 reduced alleles DRA with 1-10 RU from the Italian National Registry for FSHD recruited between January 10th, 2007 and December 20th, 2011. Participants were subdivided in probands (141, males 84) and relatives (105, males 52). Muscle impairment was measured as FSHD score and disease progression as ΔFSHD score. Clinical phenotypes were assessed and categorized on the basis of the Comprehensive Clinical Evaluation Form (CCEF). Findings: The highest ΔFSHD score (1·7) was found in subjects with full FSHD phenotype (category A) or with complex/atypical diseases (category D); subjects with incomplete clinical phenotype (category B) had lower ΔFSHD score (0·6, p<0.0001). Of 97subjects with mild or no disability (FSHD score 0-2) at baseline 63 (64·9%) maintained the same FSHD score (ΔFSHD score 0); 79·1% of asymptomatic carriers (38/48)remained asymptomatic. Disease worsened in 79·4% (112/141) of probands versus 38·1% (40/105) of relatives and advanced more rapidly in probands compared to affected relatives (ΔFSHD score 2·3 versus 1·2). We found no differences in disease progression between the two sexes (p=0·151). Among different muscles investigated by MRC grading scale, tibialis anterior was affected the most (41·0% (101/246) of subjects) at baseline; in five years its strength diminished in 49·6% (70/141) of probands. Interpretation: CCEF categories have strong prognostic effect in carriers of DRA. Assessment of clinical phenotypes and family kinship are pivotal for the clinical management of DRA carrier and should guide eligibility criteria for clinical trials. Funding Statement: Telethon Italy GUP13012, AFM Telethon 16593, Regione Emilia Romagna RARER. Declaration of Interests: The authors report no competing interests. Ethics Approval Statement: The INRF database was approved by the local ethics committee of the contributing centers. Informed written consent was obtained from all study participants, in accordance with the ethical standards of the 1964 Declaration of Helsinki.

Utilization profile of the Canadian-led coalition Role 2 Medical Treatment Facility in Iraq: the growing requirement for multinational interoperability

The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years. In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency. The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice.

Difference of achievements between physicians from public hospitals and emergency medical center in prehospital emergency.

The benefit gained by replacing physicians in the prehospital service is still controversial. The present study compared the difference of achievements of pre-hospital emergency between the physicians from public hospitals and those from the Emergency Medical Center.We included prehospital emergency patients who were sent to the hospital by ambulance after emergency calls from February 1 to May 31, 2016, in Shanghai (24,250,000 inhabitants). Cohort characteristics and diagnoses were described, and the data were analyzed using the Shanghai Emergency Medical Center's database software. We determined whether the physicians from public hospitals were associated with greater success rate of cardiopulmonary resuscitation (CPR) and examined the diseases category and the number of patients with cardiac arrest in prehospital emergency patients.During February 1, 2016, to May 31, 2016, the total turnout of ambulances in the urban area of Shanghai was 107,341 times, among which, first aid was 55,053 times. The number of patients with cardiac arrest was 3012, the 3 principal causes for cardiac arrest were Unknown diagnosis (45.19%), Cardiovascular disease (28.02%) and Respiratory diseases (11.09%), and the successful rate of CPR was 1.56%. The number of critically ill patients, encountered by the physicians from public hospitals, was 10.33% as compared to those from the Emergency Medical Center, which was 11.77% (P < .001). Although the success rate of CPR of the physicians from public hospitals was lower than that of the physicians from the Emergency Medical Center (1.22-1.58%), it did not achieve statistical significance (P > .05).Transferring the physicians from public hospitals to work in Emergency Medical Center showed no improvement in the success rates of resuscitation.